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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079200334
Report Date: 03/16/2023
Date Signed: 03/17/2023 08:23:07 AM

Document Has Been Signed on 03/17/2023 08:23 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
E BAY DELTA AC/SC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:AMAZING HOME CARE IIFACILITY NUMBER:
079200334
ADMINISTRATOR:MARILOU SOLOMONFACILITY TYPE:
740
ADDRESS:5017 SAINT GARRETT COURTTELEPHONE:
(925) 671-7909
CITY:CONCORDSTATE: CAZIP CODE:
94521
CAPACITY: 6CENSUS: 0DATE:
03/16/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:20 PM
MET WITH:TIME COMPLETED:
04:50 PM
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On 3/16/2023 at 3:20 PM Licensing Program Analyst (LPA) P. Watson arrived for a scheduled Case Management visit to conduct the final walk through for this facility to complete its closure. Upon arrival LPA was greeted by maintenance men who were working on the house who stated that the owner was not present. LPA contacted Administrator, Marilou Solomon, and left a voicemail. LPA spoke to maintenance and explained that a final walk-through was needed to be conducted. LPA then spoke to their boss and Femie Tabones, new home renter, due to them being unaware that LPA would be coming. Femie Tabones arrived at 4:37 PM and assisted LPA with the walk-through. LPA was able to complete the walk-through and concluded that no residents lived in the facility.

A copy of this report will be sent via email to the Administrator Marilou Solomon.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Paris Watson
LICENSING EVALUATOR SIGNATURE: DATE: 02/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/16/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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